{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:41:04Z","timestamp":1782927664262,"version":"3.54.5"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100007405","name":"Danish Heart Foundation","doi-asserted-by":"publisher","award":["12-04-R90-A3960-22700"],"award-info":[{"award-number":["12-04-R90-A3960-22700"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Abiomed Johnson and Johnson MedTech"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In STEMI-related cardiogenic shock, left ventricular unloading with a micro-axial flow pump (mAFP) improved survival in the Danish German (DanGer) Shock trial, though some patients in both groups required escalation to higher volume temporary mechanical circulatory support systems (tMCS). This study aims to investigate tMCS escalation strategies and outcome in non-comatose patients with STEMI-related cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this post hoc analysis of the DanGer Shock trial, patients in both study groups were stratified as escalated vs. not escalated to treatments other than a percutaneously implanted mAFP (Impella CP\u00ae). Logistic regression models were fitted to investigate the differential association of baseline markers with the likelihood of an escalation in patients randomized to mAFP vs. standard of care, adjusted for age and country. The 180-day all-cause mortality risk for the four groups was evaluated using the Kaplan\u2013Meier method. Of the 355 patients included in the DanGer Shock trial, 60 underwent tMCS escalation, 25\/179 (14%) allocated to the mAFP group, and 35\/176 (20%) allocated to the control group (adjusted odds ratio 0.52, 95% confidence interval 0.30\u20130.91). Median time from randomization to escalation was 12\u2005h (2.7\u201366.5) in the mAFP arm vs. 0.7\u2005h (IQR: 0.4\u20132.7) in the standard of care arm (P &amp;lt; 0.001). A higher baseline lactate predicted an escalation in the standard of care arm (odds ratio 1.80, 95% confidence interval 1.14\u20133.13), but not in the mAFP arm (odds ratio 0.57, 95% confidence interval 0.29\u20131.15, interaction-P &amp;lt; 0.01). Mortality was significantly higher in patients who underwent tMCS escalation (71.7% vs. 48.1%, P &amp;lt; 0.01) and highest in escalated patients from the standard of care arm (80.0%). Interestingly, those escalated in the mAFP arm had a comparable mortality risk to the non-escalated patients in the standard of care group (60.0% vs. 53.2%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the DanGer Shock trial of STEMI-related cardiogenic shock, escalation to tMCS occurred in almost 1\/5 patients, was more likely in the control group, and was associated with a higher mortality risk. Even with early escalation (&amp;lt;1\u2005h), patients escalated from the control group had the highest mortality, underscoring the need for future trials to define optimal escalation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag015","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:44:57Z","timestamp":1769172297000},"page":"466-474","source":"Crossref","is-referenced-by-count":0,"title":["Escalation of mechanical circulatory support in patients with STEMI-related cardiogenic shock: a\n                    <i>post hoc<\/i>\n                    analysis of the DanGer Shock trial"],"prefix":"10.1093","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9041-3922","authenticated-orcid":false,"given":"Benedikt","family":"Schrage","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center (UHZ), University Clinic Hamburg\u2014Eppendorf (UKE), Center for Population Health Research (POINT) , Martinistr. 52, 20251 Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5880-3733","authenticated-orcid":false,"given":"Rasmus Paulin","family":"Beske","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-0981","authenticated-orcid":false,"given":"Christian","family":"Hassager","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette Okkels","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital , Odense ,","place":["Denmark"]},{"name":"Department of Clinical Research, University of Southern , Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Eiskj\u00e6r","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0793-7923","authenticated-orcid":false,"given":"Norman","family":"Mangner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universit\u00e4t Dresden , Dresden ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Polzin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital D\u00fcsseldorf, Medical Faculty of the Heinrich Heine University D\u00fcsseldorf , D\u00fcsseldorf ,","place":["Germany"]},{"name":"Cardiovascular Research Institute D\u00fcsseldorf (CARID) , D\u00fcsseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology, Angiology and Intensive Medical Care, University Hospital Jena , Jena ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4953-601X","authenticated-orcid":false,"given":"Carsten","family":"Skurk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Campus Benjamin Franklin , Berlin ,","place":["Germany"]},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung e.V. , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2560-4068","authenticated-orcid":false,"given":"Peter","family":"Nordbeck","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital W\u00fcrzburg , W\u00fcrzburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Panoulas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, Harefield Hospital , Harefield ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-2088","authenticated-orcid":false,"given":"Sebastian","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Bonn , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3206-6162","authenticated-orcid":false,"given":"Andreas","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Br\u00fcder , Trier ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Engstr\u00f8m","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0941-378X","authenticated-orcid":false,"given":"Lene","family":"Holmvang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanna Louise Junker","family":"Udesen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital , Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3422-8700","authenticated-orcid":false,"given":"Henrik","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Odense University Hospital , Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Junker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital , Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Juhl","family":"Terkelsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, University of Southern , Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6149-7186","authenticated-orcid":false,"given":"Steffen","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Linke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universit\u00e4t Dresden , Dresden ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7542-1956","authenticated-orcid":false,"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University Heart Center, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg , Freiburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Clemmesen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center (UHZ), University Clinic Hamburg\u2014Eppendorf (UKE), Center for Population Health Research (POINT) , Martinistr. 52, 20251 Hamburg ,","place":["Germany"]},{"name":"Department of Cardiology, Zealand University Hospital , Roskilde and Nyk\u00f8bing Falster ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob Eifer","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Copenhagen ,","place":["Denmark"]},{"name":"Department of Cardiology, Odense University Hospital , Odense ,","place":["Denmark"]},{"name":"Department of Clinical Research, University of Southern , Odense 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